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Photodynamic Therapy of Corneal Neovascularization with Verteporfin

Abstract

Purpose. To describe the effect of photodynamic therapy (PDT) using verteporfin (Visudyne®) on corneal neovascularization (CNV) in two patients.

Methods. Two patients with corneal neovascularization were treated with a nonthermal laser light at 689 nm delivered 15 min after an intravenous infusion of verteporfin. Postoperative outcome of neovascularization was followed clinically (inflammation, intraocular pressure, and visual acuity) and photographically [color photographs and corneal fluorescein and indocyanine green (ICG) angiography] for a minimum of 6 months.

Results. Successful photothrombosis of corneal neovascularization was obtained immediately after treatment in the two patients, and regression was verified by corneal fluorescein and ICG angiography. In one case, partial vessel recanalization was observed after 1 month, and treatment was repeated, with complete regression of new vessels. No relevant side effects were observed in our cases.

Conclusions. PDT with verteporfin is an effective and safe procedure indicated for patients with corneal neovascularization; however, multiple sessions may be required.

Corneal neovascularization (CNV) may represent a serious clinical challenge, particularly when penetrating keratoplastly must be performed. The use of argon laser photocoagulation for treating corneal neovascularization has been described;1–4 however, it has not achieved uniform acceptance because of vessel recanalization, thermal damage to adjacent tissue, and possible worsening of the lesion. Subsequently, photodynamic therapy (PDT) with different photosensitizers 5–12 has been used successfully and safely to occlude corneal neovascularization in animals and in humans and to promote graft survival. 13 PDT is based on the interaction of light, a photosensitising drug, and oxygen. Through the generation of reactive oxygen intermediates, PDT has a potent and selective cytotoxic effect. A major mechanism of PDT is thought to be occlusion of the vascular bed, which occurs by damage to endothelial cells with subsequent platelet adhesion, degranulation, and thrombus formation. 14 More recently verteporfin, a benzoporphyrin derivative monoacid ring A (BPD-MA) photosensitizer, has become commercially available (Visudyne®) to treat subfoveal choroidal neovascularization. In the present paper we report on our preliminary clinical experience in PTD with verteporfin on CNV in two patients, adopting the same technical procedure (TAP study) 15 followed for AMD.

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